{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T06:25:24Z","timestamp":1787034324835,"version":"build-2736575974"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Thymoma-associated myasthenia gravis is a distinct clinicopathological setting in which thymic epithelial tumor biology, autoimmunity, and perioperative neurological risk overlap. In selected hypervascular thymomas, preoperative transarterial embolization is used before surgical resection, but the tissue-level correlates of the angiographic response remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective translational cohort study included 64 patients with thymoma-associated myasthenia gravis who underwent clinically indicated preoperative embolization followed by thymectomy between January 2018 and June 2025. The primary exposure was angiographic tumor blush reduction measured on digital subtraction angiography. Primary outcomes were tumor necrosis proportion, HIF-1\u03b1 H-score, and CD163-positive macrophage density. Patients were descriptively stratified into low-, intermediate-, and high-response groups according to tumor blush reduction, while continuous blush reduction was retained for regression analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 214 screened patients with thymic epithelial tumors, 64 met the eligibility criteria. Median tumor blush reduction was 56.2%. Tumor necrosis proportion increased across the low-, intermediate-, and high-response groups, with values of 30.6% \u00b1 19.4%, 40.2% \u00b1 23.5%, and 56.1% \u00b1 24.6%, respectively (P\u00a0=\u00a00.003; FDR q = 0.036). HIF-1\u03b1 H-score showed a similar pattern (111.4 \u00b1 51.6, 134.8 \u00b1 60.3, and 169.5 \u00b1 61.0; P\u00a0=\u00a00.008; FDR q = 0.048). CAIX and CD163-positive macrophage density showed unadjusted between-group differences, whereas VEGF-A, CD8-positive T-cell density, FOXP3-positive T-cell density, PD-L1 tumor proportion score, CD8\/FOXP3 ratio, and the composite immune-enriched phenotype showed broader overlap across groups. Exploratory CD20 and CXCL13 analyses did not show a graded increase across hemodynamic response strata. In multivariable analyses, each 10% increase in tumor blush reduction was associated with greater necrosis proportion and higher HIF-1\u03b1 H-score. The association between blush reduction and HIF-1\u03b1 H-score was attenuated after adjustment for necrosis proportion. Exploratory postoperative MG outcomes did not show a clear graded association with angiographic response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In embolized thymoma-associated myasthenia gravis, greater angiographic devascularization was associated mainly with ischemic necrosis and HIF-1\u03b1 expression. Immune findings were heterogeneous, with CD163-positive macrophage density showing an exploratory signal rather than a uniform immune shift. These results support an association-based interpretation and require prospective validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1926398","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:37:24Z","timestamp":1787031444000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Hemodynamic response after preoperative embolization in thymoma-associated myasthenia gravis: associations with necrosis, HIF-1\u03b1 expression, and CD163-positive macrophages"],"prefix":"10.3389","volume":"17","author":[{"given":"Hao","family":"Yang","sequence":"first","affiliation":[{"name":"Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital","place":["Taiyuan, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingtao","family":"Pi","sequence":"additional","affiliation":[{"name":"Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital","place":["Taiyuan, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendong","family":"Cao","sequence":"additional","affiliation":[{"name":"Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital","place":["Taiyuan, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duqiang","family":"Li","sequence":"additional","affiliation":[{"name":"Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital","place":["Taiyuan, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2023.1308989","article-title":"Epidemiology of thymomas and thymic carcinomas in the United States and Germany, 1999\u20132019","volume":"13","author":"Gerber","year":"2024","journal-title":"Front Oncol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2021.10.010","article-title":"The 2021 WHO classification of tumors of the thymus and mediastinum: what is new in thymic epithelial, germ cell, and mesenchymal tumors","volume":"17","author":"Marx","year":"2022","journal-title":"J Thorac Oncol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1602678","article-title":"Myasthenia gravis","volume":"375","author":"Gilhus","year":"2016","journal-title":"New Engl J Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"26","DOI":"10.21037\/med-25-28","article-title":"Pathogenesis of thymoma-associated myasthenia gravis: a narrative review","volume":"9","author":"Okuno","year":"2025","journal-title":"Mediastinum"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3390\/jpm14101019","article-title":"Preoperative embolization in the management of giant thoracic tumors: a case series","volume":"14","author":"Lucarelli","year":"2024","journal-title":"J Pers Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"297","DOI":"10.14740\/jocmr2486w","article-title":"The changes of HIF-1\u03b1 and VEGF expression after TACE in patients with hepatocellular carcinoma","volume":"8","author":"Liu","year":"2016","journal-title":"J Clin Med Res"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3390\/ijms23147864","article-title":"Unraveling the immune microenvironment of thymic epithelial tumors: implications for autoimmunity and treatment","volume":"23","author":"Masaoutis","year":"2022","journal-title":"Int J Mol Sci"},{"key":"B8","doi-asserted-by":"publisher","first-page":"5463","DOI":"10.1038\/s41467-022-33170-7","article-title":"The immune landscape of human thymic epithelial tumors","volume":"13","author":"Xin","year":"2022","journal-title":"Nat Commun"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2019.01055","article-title":"Clinicopathologic significance and immunogenomic analysis of programmed death-ligand 1 and programmed death 1 expression in thymic epithelial tumors","volume":"9","author":"Song","year":"2019","journal-title":"Front Oncol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0040296","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology statement: guidelines for reporting observational studies","volume":"4","author":"von Elm","year":"2007","journal-title":"PloS Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1212\/WNL.55.1.16","article-title":"Myasthenia gravis: recommendations for clinical research standards","volume":"55","author":"Jaretzki","year":"2000","journal-title":"Neurology"},{"key":"B12","volume-title":"Thoracic Tumours","year":"2021"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0000000000000290","article-title":"The IASLC\/ITMIG Thymic Epithelial Tumors Staging Project: proposal for an evidence-based stage classification system for the forthcoming eighth edition of the TNM classification of Malignant tumors","volume":"9","author":"Detterbeck","year":"2014","journal-title":"J Thorac Oncol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1258\/ar.2012.120339","article-title":"Interventional embolization of giant thoracic tumors before surgical resection","volume":"54","author":"Liu","year":"2013","journal-title":"Acta Radiologica"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3892\/or.2018.6667","article-title":"CRISPR\/Cas9-mediated hypoxia inducible factor-1\u03b1 knockout enhances the antitumor effect of transarterial embolization in hepatocellular carcinoma","volume":"40","author":"Liu","year":"2018","journal-title":"Oncol Rep"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.662010","article-title":"The expression of PD-L1 and B7-H4 in thymic epithelial tumors and its relationship with tumor immune microenvironment","volume":"11","author":"Yan","year":"2021","journal-title":"Front Oncol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1097\/PAI.0000000000000408","article-title":"Development of a companion diagnostic PD-L1 immunohistochemistry assay for pembrolizumab therapy in non-small-cell lung cancer","volume":"24","author":"Roach","year":"2016","journal-title":"Appl Immunohisto M M"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1177\/0218492312453462","article-title":"Preoperative embolization in surgical management of massive thoracic tumors","volume":"20","author":"Khairy","year":"2012","journal-title":"Asian Card Thorac"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/S1471-4914(02)02317-1","article-title":"HIF-1 and tumor progression: pathophysiology and therapeutics","volume":"8","author":"Semenza","year":"2002","journal-title":"Trends Mol Med"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14235905","article-title":"Tumor microenvironment in thymic epithelial tumors","volume":"14","author":"Agrafiotis","year":"2022","journal-title":"Cancers"},{"key":"B21","doi-asserted-by":"publisher","first-page":"4230","DOI":"10.1038\/s41467-022-31951-8","article-title":"Myasthenia gravis-specific aberrant neuromuscular gene expression by medullary thymic epithelial cells in thymoma","volume":"13","author":"Yasumizu","year":"2022","journal-title":"Nat Commun"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.celrep.2024.114677","article-title":"Spatial transcriptomics elucidates medulla niche supporting germinal center response in myasthenia gravis-associated thymoma","volume":"43","author":"Yasumizu","year":"2024","journal-title":"Cell Rep"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines12040772","article-title":"PD-L1 expression in neoplastic and immune cells of thymic epithelial tumors: correlations with disease characteristics and HDAC expression","volume":"12","author":"Stergiou","year":"2024","journal-title":"Biomedicines"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1158\/0008-5472.CAN-10-1439","article-title":"Macrophage expression of hypoxia-inducible factor-1\u03b1 suppresses T-cell function and promotes tumor progression","volume":"70","author":"Doedens","year":"2010","journal-title":"Cancer Res"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1038\/s41389-017-0011-9","article-title":"The hypoxic tumour microenvironment","volume":"7","author":"Petrova","year":"2018","journal-title":"Oncogenesis"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1926398\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:37:25Z","timestamp":1787031445000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1926398\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,18]]},"references-count":25,"alternative-id":["10.3389\/fimmu.2026.1926398"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1926398","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,18]]},"article-number":"1926398"}}